How to Determine if OS Site is Primary or Secondary

Q: â€œCan we discuss coding osteoarthritiséI often see it diagnosed as osteoarthritis with a specified site but not if it is primaryor secondary.â€� A: This one is pretty simple. A primary osteoarthritisis considered wear and tear, and is the most frequently diagnosed by healthcare providers.Secondary osteoarthritis has a specific cause, such as an injury or resulting from obesity,genetics, inactivity or other diseases. Then, there's also posttraumatic osteoarthritis,which is the wearing out of a joint that has had any kind of physical injury. What exactly is osteoarthritisé It's thebreakdown of cartilage causing the bones to

react to those areas, often developing bonespurs or growths. The joints may become inflamed and swollen. When the bones touch withoutthe protective cartilage, pain and stiffness result. When we're coding for osteoarthritis,we have a site and laterality designations. I find that s such as orthopedics, podiatrist,chiropractors, they tend to be much more specific with laterality and the site; however, primarycare has a tendency to just write osteoarthritis. Primary osteoarthritis typically developsaround 5560 and it is associated with aging. The longer you use your joints, the more likelyyou are to get this type of arthritis. Secondary osteoarthritis is either from aninjury, if you fracture a bone playing sports

or are in a motor vehicle accident, you willmost likely develop osteoarthritis in that joint. Obesity the extra weight bears downon the joints every day causing the joint to wear away faster. Inactivity if you areinactive, you have weaker muscles and tendons that surround the joint. Strong muscles keepthe joints properly aligned. Genetics you may carry genes that put youat risk. Then, inflammation from other diseases rheumatoid arthritis can increase your riskof getting osteoarthritis later in life. The next page is a picture of osteoarthritisof the hip. You can actually look at the two and you can see the difference between thenormal side of the hip and the one with the

osteoarthritis. The code range for osteoarthritisis M15 to M19. I just happened to pick the M16 â€“ osteoarthritis of the hip, and thelaterality is identified within the category. This is not even all of them, I just pickedthese particular codes just to show you how they're labeled. M16.0 will be bilateral primary osteoarthritisof the hip, and then .10 is the unilateral primary, unspecified hip; .11 is primary unilateral,right hip; .12 is unilateral primary, left hip; .4 is unilateral posttraumatic, unspecifiedhip; and .7 is secondary arthritis of hip, other unilateral. There are a lot more inthe M16 as well as the other codes, but I

just wanted to point out those key words:primary, posttraumatic, and secondary. Now, what you need to look for and one ofthe things you learn with ICD10 is that you're not only learning the coding, but you'realso learning the pathophysiology. First, when you're looking at the documentation,before you query the physician, wanted to see if it's in the documentation, is thehip, the knee, the carpometacarpal jointé Does it indicate in the documentation, evenif the just chose osteoarthritis, if it's left, right or bilateralé If the physician does not provide informationregarding being primary, secondary, or

posttraumatic, you may reference that inthe note. He may indicate age, or wear and tear. He may indicate that the patient isobese and gives a body mass index and so forth. You may be able to determine from the documentationif it's a primary or secondary. Does the note indicate stiffness or joint enlargementéIs there lab work indicating a white blood count or xrays takené Things like that. If you cannot figure it out based on thistype of information, then you have to query the physician. I can tell you firsthand thatthese unspecified codes are not going well with the insurance companies so you reallywant to be specific.

Hi! My name is Rotem. I'm an Exercise Physiologistand an Aquatic Therapist, and I'm here on behalf of Expert Village. The next exerciseis the trunk rotation. We'll hold our hands up in front of the body. Thumbs are touchingeach other as well as your fingers. Now, we'll turn to one side, then we'll go to the center.Now, do the other side, back to the center. Make sure you're going with your eyes withthe movement of the arms. It will help to hold your straight posture when doing this.Remember that all the time your shoulders are inside of the water so you don't feelthe pain in your joint while doing this.

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